Appendices A. Acronyms B. IAMFES: Illnesses acquired by … · 2004. 10. 31. · longer Metallic...

AppendicesA. AcronymsB. IAMFES: Illnesses acquired by ingestion of contaminated foodsC. Forms

1. Missouri Department of Health & Senior Services Disease Case Report (CD-1)2. Record of Investigation of Enteric Illness (CD-2C, 6/02) 3. Outbreak Reporting Form (12/03)

Manual Acronyms

ACIP - Advisory Committee on Immunization Practices

APIC - Association for Professionals in Infection Control

ARDS - Acute Respiratory Distress Syndrome

BCC - Bureau of Child Care

CCDM - Control of Communicable Diseases Manual

CCHF - Crimean Congo Hemorrhagic Fever

CD - Communicable Disease

CDC - Centers for Disease Control and Prevention

CD-1 - Disease Case Report form

CD-2 - Record of Investigation of Communicable Disease

CIE - counter immunoelectrophoresis

CLIA - Clinical Laboratory Improvement Amendment

CSF - cerebral spinal fluid

CSTE - Council of State and Territorial Epidemiologists

DHF - Dengue Hemorrhagic Fever

DOH - Department of Health

DRSP - Drug-Resistant Streptococcus Pneumoniae

EIA - Enzyme-linked Immuno-Assay

EEE - Eastern Equine Encephalitis

EITB - electrophoretic immunotransblot

GAS - Group A Streptococcus

HAV - hepatitis A virus

HBV - hepatitis B virus

HCV - hepatitis C virus

Hib - Haemophilus influenzae type B

HPS - Hantavirus Pulmonary Syndrome

HUS - Hemolytic Uremic Syndrome

IAMFES - International Association of Milk, food, and EnvironmentalSanitarians

IHC - Immunohistochemistry

IFA - Immunoflourescence Assay

LA - latex agglutination

LAC - LaCrosse encephalitis

LCMV - Lymphocytic Choriomeningitis Virus

LTCF - Long Term Care Facilit6y

LPHA - Local Public Health Agency

MOHSIS - Missouri Health Surveillance Information System

MMWR - Morbidity and Mortality Weekly Report

MRSA - Methicillin Resistant Staphylococcus

NF - Necrotizing Fasciitis

NNDSS - National Notifiable Diseases Surveillance System

PCR - Polymerase Chain Reaction

O&P - Ova and Parasite (stool kits, laboratory test)

PFGE - Pulsed Field Gel Electrophoresis

RIBA - Recombinant Immunoblot Assay

SCDC/VPH - Section of Communicable Disease Control and Veterinary PublicHealth

SPHL - State Public Health Laboratory

SLE - St. Louis encephalitis

STSS - Staph Toxic Shock Syndrome

TSS - Toxic Shock Syndrome

TTP - Thrombocytopenic purpura

VEE - Venezuelan Equine Encephalitis

VRE - Vancomycin Resistant Enterococcus

WEE - Western Equine enchephalitis

Reprinted with permission from Procedures to Investigate Foodborne Illness.Copyright held by the International Association of Milk, Food and Environmental Sanitarians, Inc.

Table B. Illnesses acquired by ingestion of contaminated foods: A condensed classification by symptoms, incubation periods,and types of agents

IllnessEtiologic agent and

source

Incubationor latency

periodaSings andsymptomsa

Foods usuallyinvolvedb

Specimen tocollect

Factors contributing tofoodborne outbreaks

UPPER GASTROINTESTINAL TRACT SIGNS AND SYMPTOMS [NAUSEA, VOMITING] PREDOMINATEIncubation (latency) period usually less than 1 hour

FungiGastrointestinalirritating groupmushroom poisoning

Possibly resin-likesubstances in somemushrooms (mush-room species aredifferent from thosecited on pages ***and ***)

30 min to2 h

Nausea, vomitingretching, diarrhea,abdominal pain

Many varie-ties of wildmushrooms

Vomitus Eating unknown varieties ofwild mushrooms; mistaking tox-ic mushrooms for ediblevarieties

ChemicalsAntimony poisoning Antimony in gray

enamelwareFew minto 1 h

Vomiting, abdomi-nal pain, diarrhea

High-acidfoods andbeverages

Vomitus,stools, urine

Purchasing/using antimony-con-taining utensils; storing high-acid foods in chipped grayenamelware

Cadmium poisoning Cadmium in platedutensils

15-30 min Nausea, vomitingabdominal cramps,diarrhea, shock

High-acidfoods andbeverages;metal-coloredcake decora-tions

Vomitus,stools, urine,blood

Purchasing/using cadmium-con-taining utensils; storing high-acid beverages in cadmium con-tainers

Copper poisoning Copper in pipes andutensils; old icecream machines; olddairy white metal

Few minto few h

Metallic taste, nau-sea, vomiting(green vomitus),abdominal paindiarrhea, chills

High-acidfoods and icecream (ices)andbeverages

Vomitus,gastricwashings,urine, blood

Faulty backflow preventors invending machines or soda foun-tains; storing or vending high-acid (low pH) beverages fromcopper containers, pipe lines, orold equipment containing copper


source




Specimen tocollect


Fluoride poisoning Sodium fluoride ininsecticides and ro-denticides

Few minto 2 h

Salty or soapytaste, numbness ofmouth, vomiting,diarrhea, dilatedpupils, spasms,pallor, shock,collapse

Any acciden-tally-contami-nated foods,particularlydry foods(such as drymilk, flour,baking pow-der, cakemixes)

Vomitus,gastricwashing

Storing insecticides in same areaas foods, mistaking pesticidesfor powdered foods

Lead poisoning Lead in earthenwarevessels; pesticides,paint, plaster, putty,soldered joints

30 min orlonger

Metallic taste,burning of mouth,abdominal pain,milky vomitus,bloody or blackstools, foul breath,blue gum line,shock

High-acidfoods andbeveragesstored inlead-containingvessels; anyaccidentallycontaminatedfood

Vomitus,gastricwashing,stools,blood, urine

Purchasing or using lead-con-taining vessels; storing high-acidfoods including wine in lead-containing vessels; storingpesticides in same area as food

Tin poisoning Tin in tinned cans orcontainers

30 min to2 h

Bloating, nausea,vomiting, abdomi-nal cramps, diar-rhea, headache


Vomitus,gastricwashing,urine, blood,stools

Storing high-acid foods in tinnedcans or containers in which thereis no lacquer or the lacquer hadpeeled. Very high concentrationsare required to cause illness

Zinc poisoning Zinc in galvanizedcontainers

Few minto few h

Pain in mouth andabdomen, nausea,vomiting, dizziness


Vomitus,gastricwashing,urine, blood,stools

Storing high-acid foods in gal-vanized cans


source




Specimen tocollect


Incubation (latency) period usually between 1 and 6 hBacteria

Bacillus cereus gastro-enteritis

Exo-enterotoxin ofB. cereus; organismin soil (strains dif-fer from those citedon page ***)

½ to 5 h Nausea, vomiting,occasionally diar-rhea

Boiled orfried rice,cooked corn-meal dishes,porridge,pasta

Vomitus,stool

Storing cooked foods at roomtemperature; storing cookedfoods in large containers in re-frigerator; preparing foods sev-eral hours before serving

Staphylococcal intoxi-cation

Exoenterotoxins A,B, C, D, E, F, or Hof Staphylococcusaureus. Staphylo-cocci from nose,skin and lesions ofhuman beings andother animals andfrom udders of cows

1 to 8 h,typically 2to 4 h

Nausea, vomitingretching,abdominal pain,diarrhea, pros-tration

Ham, meatand poultryproducts;cream-filledpastries;whipped but-ter; cheese;dry milk;foodmixtures;high proteinleftover foods

Ill: vomitusstools, rectalswabs. Foodhandlers: na-sal swabs,swabs of le-sions

Storing cooked foods at roomtemperature; storing cookedfoods in large containers in re-frigerator; touching cookedfoods; preparing foods severalhours before serving; holdingfoods at warm bacterial-incubation temperatures;fermentation of abnormallylow-acid foods; handling foodsby persons with pus-containinginfections


source




Specimen tocollect


ChemicalsNitrite poisoningc Nitrites or nitrates

used as meat curingcompounds

1 to 2 h Nausea, vomiting,cyanosis, headache,dizziness, weak-ness; loss of con-sciousness; choco-late-brown coloredbloodc

Cured meats;any acciden-tally-contami-nated food;spinach ex-cessivenitrification

Blood Using excessive amounts of ni-trites or nitrates in foods forcuring or for covering up spoil-age; mistaking nitrites for com-mon salt and other condiments;improper refrigeration of freshproduce; excessive nitrificationof fertilized foods

Diarrhetic shellfishpoisoning

Okadaic acid andother toxins pro-duced by dino-flagellatesDinophysis spp.

½ to 12 h,usually4 h

Diarrhea, nausea,vomiting, abdomi-nal cramps, chills

Mussels,clams, scal-lops

Gastric wash-ing

Harvesting shellfish fromwaters with higher than usualconcentration of Dinophysisspp.

Incubation (latency) period usually between 7 and 12 hFungi

Cyclopeptide and gy-romitrin groups ofmushroom poisoning

Cyclopeptides andgyromitrin in somemushrooms (mush-room species aredifferent from thosecited on pages ***and ***)

6 to 12 h Abdominal pain,feeling of fullness,vomiting,protracted diarrhea,loss of strength,thirst, musclecramps, collapse,jaundice,drowsiness, dilatedpupils, coma; death

Amanitaphalloides,A.verna,Galerinaautumnalis,Gyromitra es-culenta (falsemorels) andsimilar spe-cies of mush-rooms

Urine, blood,vomitus

Eating certain species ofAmanita, Galerina, andGyromitra mushrooms; eatingunknown varieties ofmushrooms; mistaking toxicmushrooms for edible varieties


source




Specimen tocollect


Incubation (latency) period between 13 and 72 hViruses

Small roundstructured virusgastroenteritis

Norwalk, Hawaii,Snow Mountain,Taunton Viruses:Caliciviruses

½ to 3days, typi-cally 36hours

Nausea, vomiting,diarrhea,abdominal pain,myalgia, headache,malaise, low-gradefever; duration 36hours

Human feces Stools, acuteandconvales-cent blood

Infected persons touching ready-to-eat foods; harvesting shellfishfrom sewage polluted waters;inadequate sewage disposal; us-ing contaminated water

BURNING MOUTH, SORE THROAT AND/OR RESPIRATORY SYMPTOMS AND SIGNS OCCURIncubation period less than 1 h

ChemicalsCalcium chloride poi-soning

Calcium chloridefreezing mixture forfrozen dessert bars

Few min Burning lips,mouth, throat;vomiting

Frozendessert bars

Vomitus Splashing of freezing mixtureonto popsicles while freezing;cracks in molds allowing CaCl2to penetrate popsicle syrup

Sodium hydroxidepoisoning

Sodium hydroxide inbottle-washingcompounds, deter-gents, drain cleaners,or hair straighteners

Few min Burning of lips,mouth and throat;vomiting, abdomi-nal pain, diarrhea

Bottledbeverages,pretzels

Vomitus Inadequate rinsing of bottlescleaned with caustic soda; inad-equate baking of pretzels


source




Specimen tocollect



Beta-hemolytic strep-tococcal infections

Streptococcus py-ogenes from throatand lesions of in-fected humans

1 to 3days

Sore throat, fever,nausea, vomiting,rhinorrhea; some-times a rash. Se-quela: rheumaticfever

Raw milk,egg-contain-ing salads

Throatswabs,vomitus

Persons touching cooked foods;touching of foods by personswith pus-containing infections;room-temperature storage; stor-ing cooked foods in large con-tainers in refrigerator; inade-quate cooking or reheating;preparing foods several hoursbefore serving

LOWER GASTROINTESTINAL TRACT SIGNS AND SYMPTOMS [ABDOMINAL CRAMPS, DIARRHEA] PREDOMINATEIncubation (latency) period usually between 7 and 17 h

BacteriaBacillus cereusenteritis

Enterotoxins of B.cereus. Organisms insoil (strains differfrom those cited inpage **)

8 to 16 h,mean 12 h

Nausea, abdominalpain, watery diar-rhea

Cereal prod-ucts, soups,custards andsauces, meat-loaf, sausage,cooked vege-tables, recon-stitued driedpotatoes, re-fried beans

Stools Storing cooked foods at roomtemperature; storing cookedfoods in large containers in re-frigerator; holding foods atwarm (bacterial-incubating)temperatures; preparing foodsseveral hours before serving;inadequate reheating of leftovers


source




Specimento collect


Clostridium perfrin-gens enteritis

Endoenterotoxinformed during spor-ulation of C. per-fringens in intes-tines; organism infeces of humans,other animals, and insoil

8 to 22 h,typically10 h

Abdominal pain,diarrhea

Cooked meat,poultry, gra-vy, sauces,meat-contain-ing soups, re-fried beans

Stools Storing cooked foods at roomtemperature; storing cookedfoods in large containers in re-frigerators; holding foods atwarm (bacterial-incubating) tem-peratures; preparing foods sever-al hours before serving; inade-quate reheating of leftovers


Aeromonas diarrhea Aeromonas hydro-phila

1 to 2days

Water diarrhea, ab-dominal pain, nau-sea, chills, head-ache

Fish, shellfish,snails, water

Stools Contamination of foods by seaor surface water

Campylobacteriosis Campylobacter je-juni

2 to 7days, usu-ally 3 to 5days

Abdominal cramps,diarrhea (blood andmucus frequentlyin stools), malaise,headache, myalgia,fever, anorexia,nausea, vomiting.Sequela: Guillain-Barre syndrome

Raw milk,poultry, beefliver, rawclams, water

Stools,rectalswabs,blood

Drinking raw milk; handlingraw poultry; eating raw or raremeat or poultry; inadequatecooking or pasteurization; crosscontamination from raw meat


source




Specimento collect


Cholera Vibrio cholerae se-rogroup O1 classicaland El Tor biotypes;serogroup O139

1 to 5days, usu-ally 2 to 3days

Profuse watery di-arrhea (rice-waterstools), vomiting,abdominal pain,rapid dehydration,thirst, collapse, re-duced skin turgor,wrinkled fingers,sunken eyes, acido-sis

Raw fish, rawshellfish, crus-tacea; foodswashed orprepared withcontaminatedwater; water

Stools,rectalswabs

Obtaining fish and shellfishfrom sewage-contaminatedwaters in endemic areas, poorpersonal hygiene, infectedpersons touching foods,inadequate cooking, usingcontaminated water to wash orfreshen foods, improper sewagedisposal, using night soil asfertilizer

Cholera-like vibriogastroenteritis

Non O-1/O139 V.cholerae and relatedspp. (e.g., V.mimicus, V. fluvi-alus, V. hollisae)

1 to 5days

Watery diarrhea(varies from loosestools to cholera-like diarrhea)

Shellfish, fish Stools,rectalswabs

Obtaining fish and shellfishfrom sewage-contaminated wa-ters; inadequate cooking; crosscontamination

Enterohemorrhagic orverotoxigenic Esche-richia coli diarrhea

E. coli O157:H7,O26, O111, O115,O113

1 to 10days, typi-cally 2 to5 days

Watery diarrhea,followed by bloodydiarrhea; severe ab-dominal pain;blood in urine.Sequela: hemolyticuremic syndrome

Hamburgers,raw milk, roastbeef sausages,apple cider,yogurt,sprouts,lettuce, water

Stools,rectalswabs

Ground beef made from meatfrom infected cattle; ingestingraw meat or milk; inadequatecooking; cross contamination;infected persons touchingready-to-eat food; inadequatelydrying and fermenting meats


source




Specimento collect


EnteroinvasiveEscherichia colidiarrhea

Enteroinvasive-E.coli strains

½ to 3days

Severe abdominalcramps, fever, wa-tery diarrhea(blood and mucususually present),tenesmus, malaise

Salads andother foodsthat are notsubsequentlyheated; softcheeses, water

Stools,rectalswabs

Inadequate cooking; infectedpersons touching ready-to-eatfoods; not washing hands afterdefecation; storing cookedfoods at room temperature;storing cooked foods in largecontainers in refrigerators;holding foods at warm(bacterial-incubating) tem-peratures; preparing foodsseveral hours before serving;inadequate reheating ofleftovers

EnterotoxigenicEscherichia colidiarrhea

Enterotoxigenic-E.coli strains

½ to 3days

Profuse watery di-arrhea (blood andmucus absent), ab-dominal pain, vom-iting, prostration,dehydration, low-grade fever

Salads andother foodsthat are notsubsequentlyheated; softcheeses, water

Stools,rectalswabs

Inadequate cooking; infectedpersons touching ready-to-eatfoods; not washing hands afterdefecation; storing cookedfoods at room temperature;storing cooked foods in largecontainers in refrigerators;holding foods at warm (bac-terial-incubating) temperatures;preparing foods several hoursbefore serving; inadequatereheating of leftovers; usingraw milk for cheese making


source




Specimento collect


Plesiomonas enteritis Plesiomonas shigel-loides

1 to 2days

Diarrhea (bloodand mucus instools), abdominalpain, nausea, chills,fever, headache,vomiting

Water Stools,rectalswabs

Inadequate cooking

Salmonellosis Salmonella (>2,000serovars.) from fecesof infected animals

6-72hours,typically18-36 h

Abdominal pain,diarrhea, chills, fe-ver, nausea, vomit-ing, malaise

Poultry, eggsand meat andtheir products,raw milk anddairy products,other foodscontaminatedby salmonellae(e.g., sprouts,melons, choc-olate, cereal)

Stools,rectalswabs

Storing cooked foods at roomtemperature; storing cookedfoods in large containers inrefrigerators; holding foods(including sliced melons) atwarm (bacterial-incubating)temperature; inadequatecooking and reheating; pre-paring foods several hoursbefore serving; crosscontamination; impropercleaning of equipment; ob-taining foods fromcontaminated sources;occasionally infected personstouching ready-to-eat foods

Shigellosis Shigella dysenteriae,S. flexneri, S. boydii,S. sonnei

½ to 7days, typi-cally 1 to3 days

Abdominal pain,diarrhea (stoolsmay contain blood,pus, and mucus),tenesmus, fever,vomiting

Any ready-to-eat food con-taminated byinfected per-son; frequentlysalads, poi,water

Stools,rectalswabs

Infected person touching ready-to-eat foods, improperrefrigeration, inadequatecooking and reheating


source




Specimento collect


Vibrio parahaemoly-ticus gastroenteritis

Vibrio parahaemoly-ticus

4 to 96 h,typically12 h

Abdominal pain,diarrhea, nausea,vomiting, fever,chills, headache

Marine fish,molluscanshellfish, crus-tacea (raw orrecontaminat-ed)

Stool,rectalswabs

Eating raw fin fish andshellfish; inadequate cooking;improper refrigeration; crosscontamination; impropercleaning of equipment; usingsea water in food preparation orto cool cooked foods

Yersiniosis Yersinia enterocoli-tica, Y. pseudotu-berculosis

1 to 7days

Abdominal pain(may simulateacute appendicitis);low-grade fever,headache, malaise,anorexia, chills,diarrhea, nausea,vomiting

Raw milk,tofu, water

Stools,rectalswabs

Inadequate cooking orpasteurization; contaminationafter cooking; surface or springwater as ingredients or forpacking foods; crosscontamination

VirusesAstrovirus gastroen-teritis

Astroviruses fromhuman feces

1 to 2days

Diarrhea, sometimesaccompanied by oneor more entericsigns or symptoms

Ready-to-eatfoods

Stools, acuteand convale-scent blood

Failure to wash hands after def-ecation; infected persontouching ready-to-eat foods;inadequate cooking or reheating

Norwalk and smallround structured viralgastroenteritis

(See entry under Upper gastrointestinal signs and symptoms predominate, page ***)


source




Specimen tocollect


Incubation Periods from a Few Days to a Few WeeksParasites

Amebiasis Entamoeba histoly-tica

Few daysto severalmonths,typically 2to 4 wk

Mild to severe gas-troenteritis; abdom-inal pain, constipa-tion or diarrhea(stools containblood and mucus),fever, chills, skinulcers

Raw fruit,vegetable orseafoodsalads

Stools,blood

Poor personal hygiene, infectedpersons touching ready-to-eatfoods; inadequate cooking andreheating

Anisakiasis Anisakis, pseudoter-ranova

4 to 6 wk Stomach pain, nau-sea, vomiting ab-dominal pain, diar-rhea, fever

Rock fish,herring, cod,salmon,squid, sushi

Stools Ingestion of raw fish,inadequate cooking

Beef tapeworminfection (Taeniasis)

Taenia saginata fromflesh of infectedcattle

8 to 14 wk Vague discomfort,hunger pains, loss ofweight, abdominalpain

Raw or in-sufficientlycooked beef

Stools Lack of or proper meat in-spection; inadequate cooking;inadequate sewage disposal,contaminated pastures

Cyclosporosis Cyclospora cayeta-nensis

1-11 days,typically 7days

Prolonged waterydiarrhea, weightloss, fatigue, nau-sea, anorexia, ab-dominal cramps

Raspberries,lettuce,basil, water

Stools Sewage contaminated irrigationor spraying water suspected;washing fruits with contaminat-ed water; possibly, handlingfoods that are not subsequentlyheated


source




Specimen tocollect


Cryptosporidium Cryptosporidiumparvum

1-12 days,usually 7days

Profuse watery di-arrhea, abdominalpain, anorexia,vomiting, low-grade fever

Apple cider,water

Stools,intestinalbiopsy

Inadequate sewage or animalwaste disposal; contaminationby animal manure; contami-nated water; inadequatefiltration of water

Fish tapeworm infec-tion (Diphyllobothria-sis)

Diphyllobothriumlatum from fresh ofinfested fish

5 to 6 wk Vague gastroin-testinal discomfort,anemia may occur

Raw or insuf-ficientlycooked fresh-water fish(perch, pike,turbot, trout,salmon)

Stools Inadequate cooking; impropersewage disposal; sewage-con-taminated lakes

Giardiasis Giardia lamblia 5 to 25days, typi-cally 7 to10 days

Diarrhea (pale,greasy, malodorousstools), abdominalpain, bloating, nau-sea, weakness,vomiting, dehydra-tion, fatigue,weight loss, fever

Salmon,salads, water

Stools No or inadequate hand washingafter defecation; infected per-sons handling ready-to-eatfoods; inadequate sewage dis-posal; using untreated surfacewater supplies as ingredient orfor processing

Pork tapeworm infec-tion (Taeniasis)

Taenia solium fromflesh of infectedswine

8 to 14 wk Vague discomfort,hunger pains,weight loss

Raw or insuf-ficientlycooked pork

Stools Lack of improper meat inspec-tion; inadequate cooking; im-proper sewage disposal; con-taminated pastures


source




Specimen tocollect


NEUROLOGICAL SYMPTOMS AND SIGNS (VISUAL DISTURBANCES, TINGLING, AND/OR PARALYSIS) OCCURc

Incubation (latency) period usually less than 1 hFungi

Ibotenic acid group ofmushroom poisoning

Ibotenic acid andmuscinol in somemushrooms (mush-room strains aredifferent from thosecited on pages ***and ***)

30 to 60min

Drowsiness andstate of intoxication,confusion, muscularspasms, delirium,visual disturbances

Amanitamuscaria, A.pantherinaand relatedspecies ofmushrooms

Eating A. muscaria and relatedspecies of mushrooms; eatingunknown varieties of mush-rooms; mistaking toxic mush-rooms for edible varieties; seek-ing hallucinogenic effects

Muscarine group ofmushroom poisoning

Muscarine in somemushrooms (mush-room strains aredifferent from thosecited on pages ***and ***)

15 min tofew h

Excessive sali-vation, perspiration,tearing, reducedpressure, irregularpulse, constrictedpupils, blurredvision, asthmaticbreathing

Clitocybedealbata, C.rivulosa andmanyspecies ofInocybe andBoletusmushrooms

Eating muscarine group ofmushrooms; eating unknownvarieties of mushrooms;mistaking toxic mushrooms foredible mushrooms

ChemicalsOrganophosphorouspoisoning

Organic phosphorousinsecticides (such asparathion, TEPP,diazinon, malathion)

Few minto few h

Nausea, vomiting,abdominal cramps,diarrhea, headache,nervousness, blurredvision, chest pain,cyanosis, confusion,twitching, convul-sions

Any acci-dentally-contami-nated food

Blood,urine, fatbiopsy

Spraying foods just before har-vesting, storing insecticides insame area as foods; mistakingpesticides for dried foods


source




Specimen tocollect


Carbamate poisoning Carbamyl (sevin),Temik (aldicarb)

½ h Epigastric pain,vomiting, abnormalsalivation, sweat-ing, twitching,fasciculations,contractions ofpupils, muscularincoordination

Watermelons,cucumbers,any accident-ally-contami-nated food

Blood, urine Inappropriate application forvine foods; storing insecticidesin same area as foods; mistakingpesticides for powdered foods

Paralytic/neurologicshellfish poisoning

Saxitoxin and similartoxins from dino-flagellates Alex-andrium andGymnodinium species

Few minto 30 min

Tingling, burning,numbness aroundlips and finger tips,giddiness, incoher-ent speech, diffi-culty standing,respiratoryparalysis

Mussels,clams, scal-lops

Gastricwashing

Harvesting shellfish from waterswith high concentration ofAlexandrium or Gymnodiniumspecies (Red tides)

Tetrodotoxin(Fugu/Puffer)poisoning

Tetrodotoxin fromintestines and gonadsof puffer-type fish

10 min to3 h

Tingling sensationof fingers and toes;dizziness, pallor,numbness of mouthand extremities,gastrointestinalsymptoms,hemorrhage, des-quamation of skin,fixed eyes,twitching, paraly-sis, cyanosis; fa-talities occur

Puffer-typefish

Eating puffer-type fish; failureto effectively remove intestinesand gonads from puffer-typefish if they are to be eaten


source




Specimen tocollect


Plant toxicantsJimson weed Tropane alkaloids Less than

1 hAbnormal thirst,photophobia, dis-torted sight, diffi-culty speaking,flushing, delirium,coma, rapid heartbeat

Any part ofjimson weed;tomatoesgrafted tojimson weekstock

Urine Eating any part of jimson weedor eating tomatoes from tomatoplant grafted to jimson weedstock

Water hemlockpoisoning

Resin and cicutoxinin hemlock rootCicuta virosa, C.masculate, and C.douglasii

15 to 60min

Excessive saliva-tion, nausea, vom-iting, stomach pain,frothing at mouth,irregular breathing,convulsions, respir-atory paralysis

Root of waterhemlock

Urine Eating water hemlock; mistak-ing water hemlock root for wildparsnip, sweet potato, or carrot

Incubation (latency) period usually between 1-6 hChemicals

Chlorinated hydrocar-bon poisoning

Chlorinated hydro-carbon insecticides

30 min to6 h

Nausea, vomiting,parasthesia dizzi-ness, muscularweakness, anorexia,weight loss, confu-sion

Any acci-dentally-contami-nated food

Blood,urine, stools,gastricwashing

Storing insecticides in samearea as food; mistakingpesticides for dried foods


source




Specimen tocollect


Marine PlanktonCiguatera poisoning Ciguatoxin in fatty

tissues in head andflesh of tropicalmarine fish. Frommarine plankton

3 to 5 h,sometimeslonger

Gastrointestinalsymptoms whichdisappear in a fewdays; tingling andnumbness of mouthand limbs, muscularand joint pain, dizzi-ness, cold-hot sen-sations, rash, weak-ness, slow heart-beat, prostration,paralysis; neuro-logical problemsmay last severaldays; deaths occur

Numerousvarieties oftropical fish,e.g., barra-cuda, group-er, redsnapper, am-ber jack,goat-fish,skipjack,parrotfish

Eating fatty tissues in head fleshof tropical reef fishes; usuallylarge reef fish are morecommonly toxic. (The moretoxic regions are in the SouthPacific and Indian Oceans andthe Caribbean Sea.)


source




Specimen tocollect


Incubation (latency) period usually between 12 to 72 hBacteria

Botulism Neurotoxins A, B, E,and F of Clostridiumbotulinum; sporesfound in soil, fresh-water mud andanimals

2 h to 8days, typi-cally 18 to36 h

Gastrointestinalsymptoms may pre-cede neurologicalsymptoms. Vertigo,double or blurredvision, dryness ofmouth, difficultswallowing, speak-ing and breathing;descending muscu-lar weakness, con-stipation, dilated orfixed pupils, respi-ratory paralysis; fa-talities occur

Canned low-acid foods(usuallyhomecanned);smoked fish;cooked pota-toes; onions,garlic in oil,frozen potpies, meatloaf, stewleft over-night inovens with-out heat; fer-mented fisheggs, fish,marinemammals,muskrattails, sealflippers,uneviscer-ated fish

Blood, stool,gastricwashing

Inadequate heat processing ofcanned foods and smoked fish;post-processing contamination,uncontrolled fermentations; im-proper curing of hams and fish;holding foods at room and warmtemperatures


source




Specimen tocollect


Incubation (latency) period usually greater than 72 hChemicals

Mercury poisoning Methyl and ethylmercury compoundsfrom industrial wasteand organic mercuryin fungicides

1 wk orlonger

Numbness, weak-ness of legs, spasticparalysis, impairedvision, blindness,coma

Grains treat-ed withmercury-containingfungicide;pork, fishand shellfishexposed tomercurycompounds

Urine,blood, hair

Fish harvested from water pol-luted with mercury compounds;feeding animals grains treatedwith mercury fungicicdes;eating mercury-treated grains ormeat from animals fed suchgrains

Triorthocresyl phos-phate poisoning

Triorthocresyl phos-phate used as extractsor as oil substitute

5 to 21days,mean 10days

Gastrointestinalsymptoms, leg pain,ungainly high-step-ping gait, foot andwrist drop

Cookingoils, extractsand otherfoods con-taminatedwith tri-orthocresylphosphate

Biopsy ofgastro-nemisusmuscle

Using compounds as food ex-tractant or as cooking or saladoil

GENERALIZED INFECTION SIGNS AND SYMPTOMS (FEVER, CHILLS, AND/OR MALAISE) OCCURIncubation period usually between 12-72 h

BacteriaVibrio vulnificusinfection

Vibrio vulnificus 16 h Septicemia, fever,chills, malaise,prostration; pre-ex-isting liver diseasein cases typical

Raw oystersand clams

Blood Persons with liver ailments eatingraw shellfish


source




Specimen tocollect


Incubation (latency) period usually greater than 1 weekBacteria

Brucellosis Brucella abortus, B.melitensis and B. suisfrom tissues and milkof infected animals

7 to 21days

Fever, chills, sweat-ing, weakness, mal-aise, headache,muscle and jointpain, loss of weight

Raw milk,goat cheesemade fromunpasteur-ized milk

Blood Failure to pasteurize milk, live-stock infected with brucellae

Listeriosis Listeria monocyto-genes

3 to 70days,usually 4to 21 days

Fever, headache,nausea, vomiting,stillbirths, meningi-tis, encephalitis,sepsis

Coleslaw,milk, softcheese, pate,turkeyfranks,processedmeats

Blood,urine,

Inadequate cooking; failure toproperly pasteurize milk; pro-longed refrigeration

Typhoid or paraty-phoid fevers

Salmonella typhi fortyphoid from feces ofinfected humans;other serovars. (e.g.,paratyphi A,choleraesuis,enteritidis) for para-typhoid from infectedhumans or otheranimals

7 to 28days,usually 14days

Continued fever,malaise, headache,cough, nausea,vomiting, anorexia,abdominal pain,chills, rose spots,constipation orbloody diarrhea.Sequela: reactivearthritis

Shellfish;any foodcontami-nated by in-fectedperson, rawmilk, post-process-con-taminatedmeat,cheese, wa-tercress,water

Stools,rectal swabs,blood inincubatoryand earlyacute phaseurine inacute phase

Infected persons touching foods;failure to wash hands after defe-cation; inadequate cooking; im-proper refrigeration; impropersewage disposal; obtainingfoods from unsafe sources;harvesting shellfish fromsewage-contaminated waters


source




Specimen tocollect


VirusesHepatitis A Hepatitis A virus 15 to 50

days,usually25-30

Fever, malaise las-situde, anorexia,nausea, abdominalpain, jaundice, darkurine, light-coloredstools

Rawshellfish,any foodcontami-nated byinfected per-son

Stools,urine, blood

Infected persons touching foods;failure to wash hands after defe-cation; inadequate cooking; har-vesting shellfish from sewage-contaminated waters; impropersewage disposal

Hepatitis E Hepatitis E virus 15 to 65days, usu-ally 35-40

Similar to above(high mortality forpregnant women)

Rawshellfish,any foodcontami-nated byinfectedperson

Stools,urine, blood

Infected persons touching foods;failure to wash hands afterdefecation; inadequate cooking;harvesting shellfish fromsewage-contaminated waters;improper sewage disposal

ParasitesAngiostrongyliasis(eosinophilicmeningo-encephalitis)

Angiostrongyluscantonensis (rat lungworm) from rodentfeces and soil

14 to 16days

Gastroenteritis,headache, stiff neckand back, low-gradefever

Raw crabs,slugs,prawns,shrimp,snails

Blood Ingesting raw foods, inadequatecooking

Toxoplasmosis Toxoplasma gondiifrom tissue andanimal

10 to 13days

Fever, headache,myalgia, rash

Raw orinsuf-ficiently-cooked beef,lamb, wildpig, venison

Biopsy oflymphnodes, blood

Ingesting raw meat, inadequatecooking


source




Specimen tocollect


Trichinosis Trichinella spiralis(roundworm) fromflesh of infectedswine, bear, walrus

4 to 28days,mean 9days

Gastroenteritis, fe-ver, edema abouteyes, muscularpain, chills, pro-stration, laboredbreathing

Pork, bearmeat, walrusflesh; crosscontaminatedground beefand lamb,often ingrinders

Blood,musclebiopsy, skintest

Eating raw or inadequatelycooked pork or bear meat;inadequate cooking or heatprocessing; feeding uncooked orinadequately heat-processedgarbage to swine; failure to cleangrinders between grinding porkand other meats

ALLERGIC-TYPE SYMPTOMS AND SIGNS (FACIAL FLUSHING AND/OR ITCHING) OCCURIncubation (latency) period usually less than 1 h

Bacterial (and animal) agentsHistamine poisoning(scombroidpoisoning)

Histamine-like sub-stance produced byProteus spp. andother bacteria

Few minto 1 h

Headache, dizziness,nausea, vomiting,peppery taste,burning throat, fa-cial swelling andflushing, stomachpain, diarrhea, itch-ing skin

Tuna,mackerel,Pacificdolphin(mahi mahi),blue-fish,cheese

Inadequate cooling; improperrefrigeration of fish; impropercuring of cheese


source




Specimen tocollect


ChemicalsMonosodium gluta-mate poisoning

Excessive amounts ofmonosodiumglutamate (MSG)

Few minto 1 h

Burning sensation inback of neck,forearms, chest;feeling of tightnessin chest, tingling,flushing, dizziness,headache, nausea

Foods sea-soned withMSG

Using excessive amounts ofMSG as flavor intensifier.ONLY certain individuals aresensitive to MSG

Nicotinic acid(niacin) poisoning

Vitamin, sodiumnicotinate used ascolor preservative

Few minto 1 h

Flushing, sensationof warmth, itching,abdominal pain,puffing of face andknees

Meat orother food inwhichsodiumnicotinatehas beenadded, in-cluding babyfood andbaked goods

Using sodium nicotinate as col-or preservative, improper mix-ing

a Symptoms and incubation periods will vary with the individual and group exposed because of resistance, age and nutritional status of individuals,number of organisms or concentration of poison ingested, amount of food eaten, and pathogenicity and virulence of strain of microorganism ortoxicity of chemical involved. Several of the illnesses exhibit additional symptoms and have incubation periods that are shorter or longer than stated.b Collect sample foods suspected as being the vehicle or contaminated with foodborne pathogens.c Carbon monoxide poisoning may simulate this disease. Patients who have been in closed cars with motors running or have been in rooms withimproperly vented heaters are subject to exposure to carbon monoxide.

3 NAME (LAST, FIRST, M.I.) 4 GENDER 5 DATE OF BIRTH 6 AGE 7 HISPANIC

_____ / _____ / _____

8 RACE (CHECK ALL THAT APPLY) 9 PATIENT’S COUNTRY OF ORIGIN 10 DATE ARRIVED IN USA

_____ / _____ / _____

11 ADDRESS (STREET OR RFD, CITY, STATE, ZIP CODE) 12 COUNTY OF RESIDENCE 13 TELEPHONE NUMBER

( )

14 PREGNANT 15 PARENT OR GUARDIAN 16 RECENT TRAVEL OUTSIDE OF MISSOURI OR USA 17 DATE OF RETURN

_____ / _____ / _____

18 OCCUPATION 19 SCHOOL/DAY CARE/WORKPLACE ADDRESS (STREET OR RFD, CITY, STATE, ZIP CODE)

20 WORK TELEPHONE NUMBER 21 OTHER ASSOCIATED CASES YES NO UNKNOWN 22 TYPE OF COMPLAINT/OUTBREAK

( ) IS REPORT PART OF AN OUTBREAK YES NO UNKNOWN

23 WAS PATIENT HOSPITALIZED 24 PATIENT RESIDE IN NURSING HOME 25 PATIENT DIED OF THIS ILLNESS

YES NO UNKNOWN YES NO UNKNOWN YES NO UNKNOWN

27 NAME OF HOSPITAL/NURSING HOME

28 HOSPITAL/NURSING HOME ADDRESS (STREET OR RFD, CITY, STATE, ZIP CODE)

29 REPORTER NAME 30 TELEPHONE NUMBER

( )

31 REPORTER ADDRESS (STREET OR RFD, CITY, STATE, ZIP CODE) 32 TYPE OF REPORTER/SUBMITTER

33 ATTENDING PHYSICIAN/CLINIC NAME ADDRESS (STREET OR RFD, CITY, STATE, ZIP CODE) 34 TELEPHONE NUMBER

( )

35 DISEASE NAME(S) 36 ONSET DATE(S) 37 DIAGNOSIS DATE(S) 38 DISEASE STAGE/ 39 PREVIOUS DISEASE/STAGE 40 PREVIOUS DISEASE DATE(S)37 RISK FACTOR

MISSOURI DEPARTMENT OF HEALTH AND SENIOR SERVICES

DISEASE CASE REPORTM D C C C X X

LEX ESTO

POPU L I S U P R E MA

S A LU S

UNITED

WE

ST

AND DIVIDEDW

EFALL

MO 580-0779 (9-01) (INSTRUCTIONS ON REVERSE SIDE OF FORM) CD-1

1 DATE OF REPORT 2 DATE RECEIVED BY LOCAL HEALTH AGENCY

_____ / _____ / _____ _____ / _____ / _____

MALEFEMALE

BLACK ASIAN PACIFIC ISLANDER WHITE AMERICAN INDIAN UNKNOWN

PHYSICIAN OUTPATIENT CLINIC PUBLIC HEALTH CLINICHOSPITAL LABORATORY SCHOOL OTHER ______________________

YES (IF YES NUMBER OF WEEKS _______)NO UNKNOWN

_____ / _____ / _____

_____ / _____ / _____

_____ / _____ / _____

_____ / _____ / _____

YES NO IF YES, WHERE __________________________________

FOODBORNE WATERBORNEOTHER (SPECIFY) _________________________________________________

YESNO UNKNOWN

26 CHECK BELOW IF PATIENT ORMEMBER OF PATIENT’SHOUSEHOLD (HHLD):

PATIENT

YES NO UNK YES NO UNK

HHLD MEMBER

IS A FOOD HANDLER

ATTENDS OR WORKS AT A CHILDOR ADULT DAY CARE CENTER

IS A HEALTH CARE WORKER

TEST DATE(MO/DAY/YR)

TREATED(Y/N/UNK)

SYMPTOM (IF APPLICABLE)

44 COMMENTS

SYMPTOM SITE (IF APPLICABLE) SYMPTOM ONSET DATE(MO/DAY/YR)

SYMPTOM DURATION(IN DAYS)

REASON NOTTREATED TYPE OF TREATMENT DRUG DOSAGE TREATMENT DATE

(MO/DAY/YR)TREATMENT DURATION

(IN DAYS) PREVIOUS TREATMENT PREVIOUS LOCATION(LIST CITY, STATE)

TYPE OF TEST SPECIMEN TYPE COLLECTION DATE(MO/DAY/YR)

QUALITATIVE /QUANTITATIVE RESULTS

REFERENCERANGE

LABORATORY NAME/ADDRESS(INCLUDE STREET OR RFD, CITY, STATE, ZIP CODE)

REPORT TO LOCAL PUBLIC HEALTH AGENCY

_____ / _____ / _____

_____ / _____ / _____

41 -

DIA

GN

OS

TIC

S42

- T

RE

ATM

EN

TS

43 -

SY

MP

TOM

S

SyphilisPrimary (chancre present)Secondary (skin lesions, rash)Early Latent (asymptomatic < 1 year)Late Latent (over 1 year duration)NeurosyphilisCardiovascularCongenitalOther

Gonorrhea or ChlamydiaAsymptomaticUncomplicated urogenital (urethritis,

cervicitis)Salpingitis (PID)Ophthalmia/conjunctivitisOther (arthritis, skin lesions, etc)

TB InfectionContact to TB caseImmunocompromisedAbnormal CXRForeigner/ImmigrantIV Drug/Alcohol AbuseResident, correctionalEmployee, correctionalOver 70HomelessDiabetesHealthcare workerConverter/2 yrs ≥ 10Converter/2 yrs ≥ 15

Test TypeHepatitisIgm Anti-HBcAnti-HBsAnti-HBc TotalIgm Anti-HAVHBsAgHep C

Reason not treatedFalse positivePrevious treatedAge

DrugTBIsoniazidEthambutolPyrazinamideRifampin

TBNot DoneMantouxMultiple puncture deviceX-RaySmearCulture

OtherElisaWestern BlotCultureALTAST

NOTES FOR ALL RELEVANT SECTIONS:

• Stages, risk factors, diagnostics, treatments, and symptoms shown below are examples. To see a more complete listing, please go tohttp://www .dhss.state.mo.us/Diseases/DDwelcome.htm . You may also contact the Office of Surveillance at 1-800-392-0272 foradditional information or to report a case.

• All dates should be in Mo/Day/Year (01/01/2001) format.• All complete addresses should include city, state and zip code.• Required fields referenced below are italicized and bold, however fill form as complete as possible.

(1) Date of Report -- date sent by submitter of document.

(2) Date received will be filled in by receiving agency.

(3-8) CASE DEMOGRAPHICS/IDENTIFIERS: Last name, First Name, Gender, Date of Birth, Hispanic, Race - please check all that apply

(23) Was patient hospitalized due to this illness?

(32) Type of reporter/submitter (doctor, nursing home, hospital, laboratory) (33-34) Attending physician or clinic (full physician name anddegree, address, phone)

DISEASE: (35) Disease name or name(s), (36) Onset date(s), (37) Diagnosis Date(s)

(38) Disease Stage or Risk Factor

(39) Previous Disease/Stage (if applicable) (40) Previous Disease Dates (if applicable)

(41) Diagnostics (Please Attach Lab Slip)

Specimen T ype (blood, urine, CSF, smear, swab), Collection Date (Mo/Day/Yr), Qualitative (negative, positive, reactive),Quantitative Results (1:1, 2.0 mm reading,) Reference Range (1:1neg, 1:64 equivocal, 1:128 positive, > 2 positive),Laboratory (name, address)

(42) TREATMENT

(43) SYMPTOMS:Symptom (jaundice, fever, dark urine, headache) Symptom Site (head, liver, lungs, skin), Symptom Onset Date (Mo/Day/Yr)and Symptom Duration (in days)

(44) Comments: Attach additional sheets if more comments needed.

MO 580-0779 (9-01) CD-1

MISSOURI DEPARTMENT OF HEALTH AND SENIOR SERVICES SECTION OF COMMUNICABLE DISEASE CONTROL AND VETERINARY PUBLIC HEALTH

RECORD OF INVESTIGATION OF ENTERIC ILLNESS MOHSIS CID#

Information with shaded titles is not required if entered on the CD-1 report or entered into MOHSIS. NAME: (LAST, FIRST, MI) DATE OF BIRTH: AGE: GENDER: RACE: / /

PARENT(S) NAME IF NOT ADULT: PHONE NO.:

HOME ADDRESS: CITY: STATE: ZIP CODE: COUNTY:

EMPLOYMENT / CHILD CARE (*See reverse side for High-Risk Employment information.) PLACE OF EMPLOYMENT: ADDRESS: PHONE NO.:

OCCUPATION: JOB DUTIES:

SCHOOL / CHILD CARE ATTENDED: GRADE OR ROOM:

SCHOOL / CHILD CARE ADDRESS: CITY: STATE: ZIP CODE:

Symptoms:* (Check Yes or No and number the order in which symptoms first presented) ORDER NO. SYMPTOM YES NO ORDER NO. SYMPTOM YES NO ORDER NO. SYMPTOM YES NO

Nausea Bloody Diarrhea Malaise Vomiting Cramps Headache Diarrhea Chills Dizziness Watery Diarrhea Fever__________° Other

Disease DIAGNOSIS: ONSET DATE / TIME:* DURATION OF SYMPTOMS: / / am pm

__________________ hrs. INCUBATION PERIOD:* PHYSICIAN CONSULTED? DATE: HOSPITALIZED?

Yes No / / Yes No PROVIDER NAME: CITY: STATE: PHONE NO.:

TREATMENT: (TYPE, AMOUNT) DATE:* / /

DATE OF DEATH: CAUSE OF DEATH: Recovered Died / /

Patient History (Limit patient responses to within one disease incubation period.) TRAVEL: (OUTSIDE OF HOME COMMUNITY) DATE(S):* LOCATION(S):

Yes No

HOME WATER SUPPLY:

Private (type)______________________________________________ Public Water District (Name)__________________________________

Bottled Water (brand) _________________________________________ Other water sources: ____________________________________________

HOME SEWAGE DISPOSAL SYSTEM:

Private (type)______________________________________________ Community System (Name) ____________________________________ RECREATIONAL WATER CONTACT: (SWIMMING POOL, LAKE, RIVER, ETC.)

Yes No Type: ______________________________________ Location:_________________________________________________ Dates:* __________________________________________________

PET / ANIMAL EXPOSURE: (DOMESTIC PETS, LIVESTOCK, OTHER)

Yes No Pets/Animals ill: Yes No Animal Type(s):____________________________________________________ Date(s)* of Animal Exposure: _________________________________________

Describe Animal Exposure: _____________________________________________________________________________________________________ Location of Animal Exposure:____________________________________________________________________________________________________ Comments: __________________________________________________________________________________________________________________

Food** NAME STREET ADDRESS CITY / STATE

Grocery stores routinely used:

_____________________________________ _____________________________________ _____________________________________

_____________________________________ _____________________________________ _____________________________________

_____________________________ _____________________________ _____________________________

Restaurants routinely used:

_____________________________________ _____________________________________ _____________________________________

_____________________________________ _____________________________________ _____________________________________

_____________________________ _____________________________ _____________________________

OTHER FOOD SOURCES: (e.g., ETHNIC, UNPASTEURIZED, HOME CANNED) TYPE / LOCATION:

* Epi Calendar (reverse side) may be used to help determine time periods. ** Attach separate 3-day food history if multiple cases are known/suspected. Please submit this form along with

completed CD-1 Report on all enteric cases. MO 580-0802 (6-02) CD-2C

Laboratory Tests*: Record Diagnostic Information in Section 41 of CD-1 Report and/or attach copy of lab slip(s)

Are there other associated cases? Yes No If yes, how many? How Associated:

List ill contacts: SIMILAR ILLNESS

LAB CONFIRMED

CD-1 AND ENTERIC FORM

COMPLETED NAME & ADDRESS DOB / AGE SEX RELATION

TO PATIENT

YES NO

ONSET DATE

YES NO YES NO

High Risk Employment Information (e.g., Food Handler, Child Care or Health Care Worker) SPECIFIC JOB DUTIES:*

DATE(S) WORKED PRIOR TO ONSET OF ILLNESS:* EXCLUDED FROM WORK? Yes No

DATE:*

/ / IF YES, BY WHOM:

TITLE:

FOLLOW-UP SPECIMEN(S) REQUIRED? Yes No

DATE COLLECTED:* / /

RESULTS:* 1. _____________________ 2. ______________________ 3. ______________________

LAB:

WERE CONTROL MEASURES DISCUSSED WITH PATIENT? Yes No

BY:

RETURNED TO WORK? Yes No

DATE:* / /

EXPECTED DATE:* / /

EXCLUDED FROM HIGH-RISK DUTIES? Yes No

SEXUAL PREFERENCE:

Heterosexual Homosexual Bisexual Unknown N/A MULTIPLE PARTNERS?

Yes No RECREATIONAL DRUG USE:

Yes No DRUGS OF CHOICE:

*Epi Calendar: MONTH(S) / DATES: YEAR: DISEASE: WORK:

Sunday ____ Monday ____ Tuesday____ Wednesday____ Thursday ____ Friday ____ Saturday ____



OTHER PERTINENT EPIDEMIOLOGICAL DATA (TO INCLUDE PROBABLE SOURCE): ____________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

INVESTIGATOR: DATE COMPLETED:

MO 580-0802 (6-02) CD-2C

MISSOURI OUTBREAK SURVEILLANCE FORM

ID: OUTBREAK NAME: ENTRY DATE: PERSON RECEIVING REPORT:_____________________________________________ REPORT DATE: _______________ REPORTED BY: (check 2-digit code) 01 Local Health Dept 05 Nursing Home/Long Term Care 09 Private Physician/health care Provider 02 Regional Office 06 Child Care 10 Private Citizen 03 Hospital 07 School/College 11 Other State Agency 04 Laboratory (non-hospital lab) 08 Industry Worksite 12 Other, specify ____________ DATE OF REPORT TO LOCAL HEALTH AGENCY: EVENT DESCRIPTION: (circle 2-digit code) 01 Outbreak or possible outbreak 04 Cluster of Events 07 Other, specify _______________ 02 Case Report 05 Sensitive Event 03 Toxic Exposure 06 Artifact (false alarm) CRITICAL EVENT DATE: Number of persons reported ill: Number of persons hospitalized: Number of reported deaths: Estimated number of persons exposed/at risk: SUSPECTED LOCATION OF EXPOSURE:

In state Out of State Out of Country County:___________ State: __________ Country: ____________________ GENERAL CATEGORY: (circle 2-digit code) 01 Infectious Disease 05 Environmental Hazard (noninfectious 02 Special Syndrome (Reye, Kawaski, GBS) 06 Occupational Hazard (noninfectious) 03 Injury/Trauma 08 Other, specify:_______________________ 04 Chronic Disease 09 Unknown SUSPECT MODE OF TRANSMISSION: (circle 2-digit code) 01 Food 04 Air 07 Environmental Exposure 02 Water 05 Person-to-person 08 Worksite Exposure 03 Vector 06 Medical Procedure/Medication 09 Other, specify:_______________ What is the specific suspect vehicle (product) or vector?

EXPOSURE SETTING/POPULATION AT RISK: (circle 2-digit code) 01 Camp 09 Immigrant/Alien 18 Institution/Prison 02 Childcare 10 Military Base/Camp 19 Healthcare Facility/Hospital/ 03 Church/Temple 12 Occupational/Workplace Clinic/Medical Care Site/ 04 Club/Health Spa 14 Resort/Hotel Nursing/Long Term Care 05 Disaster (natural or man-made) 15 Restaurant/Food Service 88 Other, specify 06 General Community 16 School/College 99 Unknown 07 Home/Private Gathering 17 Catered Event SPECIFIC CAUSE: (circle 3-digit code) 151 AGI* 048 Hepatitis, NANB 103 Reye Syndrome 056 AIDS 012 Hepatitis (unspecified) 105 Rheumatic Fever 104 Amebiasis 106 Influenza 025 Rocky Mtn Spotted Fever 217 ARI** 049 Legionellosis 020 Rubella 001 Aseptic Meningitis 038 Hansen Disease (Leprosy) 100 Salmonella, serotype: ____________ 152 Bacillus Cerus 039 Leptospirosis 225 Scabies 053 Botulism, foodborne 158 Listeriosis 160 Scombrotoxin 002 Brucellosis 108 Lyme disease 101 Shigellosis 102 Campylobacteriosis 013 Malaria 200 Silicosis 003 Chickenpox 050 Measles (indigenous) 161 S. Aureus 153 Ciguatoxin 051 Measles (imported) 219 S. Aureus - MRSA*** 154 C. perfringens 016 Meningococcal infection 162 Strep group A 155 Cryptosporidiosis 018 Mumps 032 Syphilis 004 Diphtheria 555 Norwalk-Like Virus 021 Tetanus 156 E. coli O157:H7 019 Pertussis 052 Toxic Shock Syndrome 005 Encephalitis, primary 044 Plague 027 Trichinosis 218 Fifth Disease 041 Polio, (paralytic) 022 Tuberculosis 157 Giardiasis 045 Psittacosis 023 Tularemia 029 Gonorrhea 159 Pseudomonas 024 Typhoid Fever 011 Hepatitis A 034 Rabies (animal) 026 Typhus (murine) 010 Hepatitis B 046 Rabies (human) 047 V. cholerae - 01 777 Environmental hazard or toxin: specify _________________________________ 226 V. cholerae non-01 888 Other, specify _____________________________________________________ 163 V. parahaemolyticus 999 Unknown *Acute Gastrointestinal Illness of unknown etiology **Acute Respiratory Illness of unknown etiology ***Methicillin Resistant S. aureus

LEVEL OF INVESTIGATION BY LOCAL AGENCY: 01 Received report 04 Onsite visit or assistance 06 Referred to Regional office 02 Handled by other person/office/agency 05 Primary responsibility for investigation 03 Consultation is provided by phone or mail Responsible agency: __________________________

SHADED AREAS TO BE COMPLETED BY REGIONAL OFFICE LEVEL OF INVESTIGATION REGION:_______________ 01 Received report 03 Consultation provided by phone or mail 05 Primary responsibility for investigation 02 Handled by other person/office/agency 04 Onsite visit or assistance 06 OTHER:__________________________

STATUS OF REPORT: Check one: Provisional Administratively Closed Final*

Comments: ______________________________________________________________________________________________________________________________________________________________________________________________________________________

Form completed by: ____________________________________________ Date: ______________________________________ *A summary/writeup must be included. Revised 12/03

Appendices A. Acronyms B. IAMFES: Illnesses acquired by … · 2004. 10. 31. · longer Metallic...

Documents

Transcript of Appendices A. Acronyms B. IAMFES: Illnesses acquired by … · 2004. 10. 31. · longer Metallic...